BACKGROUND AND OBJECTIVE: Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. PATIENTS AND METHOD: Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used. RESULTS: Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. CONCLUSION: Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.
BACKGROUND AND OBJECTIVE:Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. PATIENTS AND METHOD: Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used. RESULTS: Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. CONCLUSION: Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.
Authors: Alejandro Lizaur-Utrilla; Blanca Gonzalez-Navarro; Maria F Vizcaya-Moreno; Francisco A Miralles Muñoz; Santiago Gonzalez-Parreño; Fernando A Lopez-Prats Journal: Int Orthop Date: 2018-05-09 Impact factor: 3.075